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Submission to the National Inquiry

into Children in Immigration Detention from



Nursing in a Detention Centre -

‘The Rules’

I looked up and saw a

long line of men, women and children waiting to have their blood taken. I was

standing beside a small table in a RAAF tent with a co-worker. It was 40 degrees

Celsius in the Kimberly November humidity. Both ends of our tent were open in

a vain attempt to get a breeze through as we worked side by side with flies

buzzing around our faces and hands and sweat running down our bodies. This was

my first impression of a detention centre.

It was the first time I

had been in a detention centre. I was at Curtin IRPC which stands for Curtin

Immigration, Reception and Processing Centre and is 45kms from Derby on the

mothballed Curtin air force base in the Kimberly in Western Australia's far

north. Curtin was originally established to temporarily accommodate about 300

people due to the sudden rise of boat people arrivals exceeding the capacities

of the permanent detention centres. Soon Curtin's population doubled and then

doubled again with the original detainee accommodation being supplemented with

tents. Camp development began in a frenzy and was continuing when I left over

two years later.

It was only a few years

ago that I was taking a break from my usual emergency nursing focus to be a

graduate midwife at Derby hospital. The local Path lab recruited some of us

nurses to assist them as venepuncturists at the detention centre for health

screening of new detainees. That was in late 1999. When I left Curtin for the

last time earlier this year I was the Health Services Coordinator, answering

directly to the Centre Manager and then the Health Services Manager in the Australasian

Correctional Management (ACM) Sydney Head Office. When I started we had a handful

of nurses, one locum doctor and one demountable building for us all to work

from while using detainees as interpreters. When I left we had 4 demountables,

a multidisciplinary team of health professionals and access to professional


Nurses are the front line

and the heart of health care in detention centres. The health manager is called

the Health Services Coordinator and this is a nursing position. Whomever fills

this position is the team leader for not only the nurses but also the counsellors,

psychologist and doctor. This person ensures that not only is health screening

done but that ongoing health care is provided. At Curtin I was lucky to be able

to develop and be a part of a team of professionals.

The nurses and others in

the health team must work in a security environment dealing with traumatised

clients of a different cultural and mostly non-English speaking background.

All health staff must be

adaptable and able to work with chronic and acute case loads daily. If you're

lucky your doctor can perform as a GP as well as an emergency physician. If

not then the nurses will, so you will need to have the skills of a remote area

nurse along with your Critical Incident skills.

Before I continue I must

comment on how politics has become an integral part of detention nursing. Not

withstanding this fact, and whatever the politics of detention are, the simple

fact remains that while mandatory detention remains government policy there

will be a need for nurses to provide quality health care in these detention


Unfortunately the Australian

community is polarised in regards to the issue of refugee versus illegal immigrant.

Some people, including friends of mine, think detention centre clients are all

Al Quida members while other people, including some other friends of mine, believe

they are all helpless refugees. Nurses don't like being the piggy in the middle.

The more we talk about nursing in detention centres the more ammunition we seem

to provide to extremists. How? Because people will tend to choose what they

remember we say. If I talk about manipulative clients or e.g. the detainee at

Curtin who I was told allegedly talked to a guard about coming terrorist attacks

in America only a week before September 11, then the One Nation supporters lap

it up. If I talk about the photographs I've seen of Taliban torture, executions

of women and children or the brutal behaviour of ACM guards and immigration

(DIMIA) officials, then the refugee activists say they are all poor refugees.

You cannot be a detention

centre nurse and not deal with politics. That is the first rule of being a detention


Today I wanted to talk

about being a nurse. Unfortunately no one can separate the nursing role from

Party politics. Everything you do at your work, you must expect to be examined

by some human rights committee or be talked about in parliament. Leading up

to the last federal election I was constantly reminded by my superiors that

the detention issue had the potential to bring down the Federal government.

What we learnt is that it could also save the government.

The second rule of being

a detention nurse is that anyone who enters a detention centre is there because

they have entered the country illegally or violated their visa requirements.

According to the Federal government you are not a refugee until they say you

are. Processing of refugee claims are supposed to be completed within fourteen

weeks of arrival. Some take up to six months. These determinations are made

by the Department of Immigration, Migration and Indigenous Affairs - DIMIA.

Those still in detention after this time are either awaiting deportation or

are appealing their visa refusal. This issue is very relevant to the detention

nurse. You are an impartial health practitioner and are forbidden by DIMIA to

comment on visa matters. Meanwhile you need to be aware of your client’s

case status because it will influence how you deal with them and may indicate

what their state of mind may be. This information is handy for example when

dealing with suicidal clients. You are an employed by Australasian Correctional

Management (ACM). The immigration department, known as DIMIA, contracts ACM

to run the centres while still having their own officers on site to oversee

operations. As a nurse you deal with health issues not immigration issues.

Therefore the third rule

of being a detention centre nurse is to know your brief. The duties of a detention

nurse are quite clear. You are to provide for all the health care needs of your

client group while they are in detention. Your employer is a private company

so the focus begins with minimising expenditure. This strategy has developed

some limitations recently because the human rights groups and refuge advocacy

groups have learnt what specific questions to ask about a particular clients

care. DIMIA and ACM are now acutely paranoid about these groups and their influence.

Let me illustrate this point.

A disabled child arrived

one December and I was told by both an immigration and ACM manager to do nothing

for him other than what I would do for any able bodied child as he would probably

be released soon. Why should we pay for anything when the State will when he

is released, I was told. By February I am told to start organising services.

For a child who allegedly has never had any specialised care we logically started

with arranging specialist health assessments eg an Occupational Therapist assessment.

These have to be booked with the local health services with the obligatory waiting

time. In March, after the mother had complained to DIMIA about herself and her

disabled child being kept in detention, a senior ACM manager comes to a Health

Clinic staff meeting where I am abused in front of my staff for not having done

anything "since December". The lesson here is that there is no need

to provide the health care required unless there is a chance that that DIMIA

&/or ACM can come under criticism.

This also raises the interesting

point that it is actually in the interests of the ill and disabled to enter

Australia illegally because you then have a chance of a visa. Not a better chance

- A chance. If the same person applied from overseas they would have no chance

of a visa because DIMIA would simply not accept anyone that may cost them money

to provide services to e.g. health care. You may remember the gentleman who

last year set fire to himself on the steps of parliament house. He did so to

protest the fact that the government would not accept his daughter into Australia

because she has cerebral palsy. The government does not dispute this - it admits

it as it is now a vote winner.

The fourth rule of detention

nursing is that whatever DIMIA wants they get. For example ACM has a policy

that I was instructed to enforce, by my health line manager in head office,

that states that if a DIMIA official wishes to view a detainee’s medical

health record then they need to obtain the detainee’s written permission.

I informed the local DIMIA official who told me in no uncertain terms that I

was to instead do what he says. Soon the inevitable request for a medical health

record came to which I requested DIMIA provide evidence of the detainee giving

permission. In full view of ACM and DIMIA staff, as well as detainees, this

career immigration official yelled abuse at me, threatened to have me permanently

removed from the premises and then, while physically threatening me, he proceeded

to remove medical health records from the clinic. At this time I was told by

the on site senior ACM manager to give any immigration officer whatever they

wanted whenever they wanted it despite our company's policies and despite my

direct instructions from ACM Head Office.

Despite the obvious bullying

and intimidation I never got support from ACM. My health line manager did attempt

to address this issue for me but to no avail as senior ACM management do not

want to offend DIMIA. The detention contract comes first - staff are expendable.

My written request to the Nurses Board of Western Australia, hand delivered

to a Board member, about my legal responsibilities relating to health record

storage and access, went unanswered.

DIMIA will always do what

they want to do. ACM can be fined by DIMIA if there are breaches of contract.

My on site manager told me once how DIMIA was fining ACM for using detainees

as interpreters. The incident reported was allegedly when some new detainees

arrived at Curtin that the ACM manager used one of them, who could speak English,

to translate for him as he spoke to the new arrivals. What my ACM manager told

that had really happened was that it had been the DIMIA manager who had asked

the new arrivals if any could speak English. When some came forward the DIMIA

manager used them to translate for him and then gave them over to the ACM manager

to use. This was the same DIMIA manager who then fined ACM for using detainees

as interpreters. The point was pretty irrelevant for me because ACM head office

had authorised a payment schedule for detainee workers which included using

detainees as interpreters in the Health Clinic. This was despite me complaining

that it was unprofessional/unethical et cetera and that we should at least have

phone lines installed for telephone interpreters as there were (and still is)

insufficient on site official interpreters. I was ignored. DIMIA can behave

in any manner and get away with it.

My days with ACM were finally

numbered when I was posted to Christmas Island. While there I refused to be

the escort nurse for two pregnant women who were being forcibly separated from

their husbands and children so that they could be taken to the mainland to have

their babies. Their families were not allowed to accompany them because once

on the Australian mainland they would be able to apply for a visa. Breaking

up families meant that the wife would voluntarily leave the mainland to reunite

with her family. These ladies would. Especially because while on the mainland

they are kept in isolation from other detainees. They were also not told their

legal rights.

This separation and isolation

of pregnant women is wrong on so many levels: ethically, professionally, medically

- it is appalling that it could happen. But I was told later by an ACM health

manager that yes, my refusal to do the escort was a difficult ethical decision

that I had made but I'm a manager now and I have to rise above such things.

So here I have an ACM health manager I have to rise above my ethics. I have

to follow the instructions of a politician despite all the scientific research

that states such a separation at such a time for such a duration is grossly

negligent and could even be construed as abuse. I think I’ll stick to

my ethics. To top this incident off, when these ladies did arrive at Curtin,

I was asked by a DIMIA official if I was going to provide any care for them.

Ignoring the insult, I stated that just because I objected to DIMIA transferring

these women without their families, that does not mean that I would contribute

to their distress by refusing them health care. These ladies were not the problem

- DIMIA’s unethical treatment of them was.

Final rule. Everything

that goes wrong is the fault of the individual, everything that succeeds is

a result of company policy. There is a culture of blame in detention nursing

that is entrenched and unavoidable. As a detention nurse you are the classic

weak link. You are a care bear and therefore you are not to be trusted. If there

was a leak then it must have been the nurses. The detention officers will always

accuse a nurse to protect themselves even if it means being creative with the


We had a depressed detainee

who had requested to be put into a quiet room separate from others. We complied

thinking that a little time apart, with free access to his friends may be beneficial.

Unfortunately this man’s depression increased, and his appetite decreased

dramatically. He was monitored closely by the health staff and detention officers.

He was not on a hunger strike. One evening he was unwell and the detention officers

called for a nurse to visit him. Because of the man’s depression the nurse

also called the counsellor to attend. The detainee’s mouth was very dry

and although willing to drink he said he was too uncomfortable. He could not

even manage to take crushed ice. The nurse said if he was unable to drink or

eat that he may need intravenous (IV) rehydration. She was then called away

to attend someone else. After talking to the counsellor for a while the detainee

presented to the health clinic requesting intravenous rehydration. The nurse

contacted the doctor and the detainee was rehydrated.

Now if this man had been

on a hunger strike, DIMIA would have been notified. If he had refused to eat

and drink for so long that his health had been compromised the nurses would

have informed DIMIA and the doctor could have obtained permission from the Federal

Immigration Minister for permission to forcibly rehydrate him. This was not

such a case. Never the less as this man was rehydrated a detention officer rang

DIMIA and informed them that a hunger striker had been rehydrated.

The result of this ACM

officer not bothering to ask the nurse what she was doing was that the DIMIA

official stormed into the health clinic, verbally abused the nurse (in front

of detainees and other ACM staff) for not informing them about this “hunger

striker” and how dare she rehydrate him “without Ministerial permission”!

The DIMIA official then took the detainees medical health record without permission

(and while the nurse was still using it) and stormed out. The health record

was later found in the Shift Managers office where the DIMIA official had left

it lying about unattended. When ACM called an official investigation, as a result

of the DIMIA complaint about breach of process, I was told by the acting senior

ACM manager, at a managers meeting, that I was at fault but that the investigation

would be impartial. The investigating officer eventually found that Policy had

not been breached and that blame could not be put onto one person.

When the senior ACM manager

returned he discussed the issue with me. He told me not to take it personally

and that some things I just have to accept and then move on. He then went on

to inform me that the investigating officer was incorrect in his findings and

that he had informed the investigating officer what his findings should have

been and will be. These were that my nurses and I were at fault for, apart from

other things, not notifying him and DIMIA that this man was on a hunger strike.

Therefore the nurses including myself would be receiving disciplinary letters

and that DIMIA will then be satisfied that ACM had corrected the fault. This

gross manipulation of an official investigation was appalling.

To crucify someone just

to satisfy DIMIA’s complaint was unacceptable. I submitted an official

complaint about this as well as the DIMIA officials bullying and harassment

of my nurse. The new investigation (undertaken by my health line manager from

Head Office) exonerated my nurses and I but again nothing was done about the

bullying and harassment conducted by DIMIA officials.

I mentioned that I'm a

house dad now. Not a domestic engineer or such rubbish euphemism - I'm a house

dad. No I don’t find it boring. You'd think so after my doing four years

of acute A&E nursing, studying and then practicing midwifery and then being

at the coal face of detention nursing for over two years. I've actually become

a resource person for detention nurses who ring me for legal direction and yes,

emotional support.

Unfortunately there is no organisation like a Detention Nurses Association for

nurses to met with and discuss professional or industrial issues. If there are

local organisations for prison nurses then I suggest that detention nurses join

these, as well as the ANF, of course. After all detention nurses work for a

company whose main focus is gaols, as their name states: Australasian Correctional

Management. I'm finding my support role decreasing as more and more nurses who

know me leave ACM. That is not to say that the debriefing has finished. Mine

is ongoing six months later.

I'm sorry I couldn't give

a totally dispassionate speech about the joys of detention nursing. I

am here to give you my experience. There were some detainees that I wish

to never see again while there were some beautiful clients that I have

met and yes, that I miss looking after. But I have friends like myself

who were discarded by ACM when we became burnt out or perceived as a liability

just as I also have friends who have resigned in disgust at the management

practices of ACM, DIMIA and the politicians dictating healthcare. Many

nurses have been worn down by the constant harassment and bullying in

the work place from detention officers, DIMIA officials, ACM management

and also from detainees. Most of all we are tired of the fact that we

cannot give the care we wish to. In that we are just like so many other



Updated 9 January 2003.